Archived: Beechfields Nursing Home Limited

Beechfields is a care home providing accommodation and nursing care to up to 35 people aged 65 and over. At the time of the inspection, there were 18 people living at the home, some of who were living with dementia. The accommodation is provided in one building over two floors. There are three communal lounges, a dining area, a conservatory and a garden area that people can access.

People’s experience of using this service:

Improvements had been made and people received their medicines as prescribed. Risks associated with people’s care and the home environment were assessed and managed safely. Staff understood people’s needs and knew what actions to take to reduce any identified risks.

There were enough, suitably recruited staff who worked well as a team to ensure people received timely support. Staff received an induction and ongoing training and supervision to fulfil their role. Staff had a good understanding of how to recognise and report potential abuse. Any concerns raised were acted on by the registered manager in line with local safeguarding procedures.

Quality checks had been improved and there was greater oversight at the service. However, further work was needed to ensure systems were consistently effective and improvements sustained.

Staff had received training and supported people to have maximum choice and control over their lives. However, improvements were needed to ensure people’s consent to care was consistently recorded in line with the legal requirements.

Staff were kind and caring and had good relationships with people. They understood people’s needs and preferences and provided personalised care. People were involved in developing their care plans and work was ongoing to ensure they were kept up to date and reflected people’s needs and preferences accurately. There were opportunities for people to engage in activities that promoted their wellbeing.

People were supported to access other health professionals and have enough to eat and drink to maintain good health. Changes had been made to ensure people received the support and encouragement they needed with their meals. However, further improvements were needed to ensure people always received this in a timely way.

People and their relatives were positive about the improvements made at the service and were confident in the registered manager’s leadership of the staff. People knew how to raise any concerns and complaints and there was a procedure in place to manage this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection:

Inadequate (report published 15/08/2018).

Why we inspected:

At our previous three inspections in in June 2017, February 2018 and June 2018, we rated the service as Inadequate and placed them in special measures. At each inspection we found repeated breaches of the regulations and insufficient improvements had been made by the provider. When services in special measures do not make the required improvements, we take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This inspection was carried out as part of our enforcement process to check for improvements and to review the ratings. We found the provider had made significant improvements although there remained a breach of the regulations in relation to governance at the service.

Enforcement :

You can see what action we have told the provider to take at the end of the full report.

Follow up:

We will continue to monitor the service closely to ensure the provider sustains the improvements made and improves the rating to at least Good.

Following the inspection we wrote to the provider and asked them to take urgent action due to the significant concerns we found. We carried out a second day of inspection on 4 July 2018 to check if the provider had taken the action they had told us they had taken in the action plan they sent to us.

Beechfields Nursing Home Limited is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Beechfields Nursing Home Limited is registered to accommodate 35 people in one building. Some of the people living in the home are living with dementia. At the time of our inspection 23 people were using the service. Beechfields Nursing Home Limited accommodates people in one building and support is provided over two floors. There are communal lounges and dining areas, a conservatory and a garden area that people can access.

There is not a registered manager in place. Since our inspection a new manager has been appointed and is in the process of registering with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in November 2017 we rated the service as inadequate .Following that inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. The provider has been sending us monthly actions plans.

At this inspection we found people continued to wait for support. This included when they needed support with eating and drinking and support with their mobility. The lack of staff support placed people at risk. Risks to people were not always investigated or reviewed after incident and accidents occurred within the home, or action taken to reduce the risk reoccurring. This information was not used so that lessons could be learnt in the future. When people displayed behaviours that may challenge we could not be sure the behaviour management plans in place gave staff the information to offer a consistent approach. People were not protected from potential abuse as incidents were not reported appropriately when needed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Staff received an induction and training, however we could not be assured how effective this was as staff competency and knowledge was not always checked or considered by the provider.

Improvements had been made to the management of medicines, however we found some medicines were unaccounted for and the system the provider had in place had not identified this. Audits were completed, however they were not effective in identifying areas of improvement and it was unclear how the information was used to drive improvement within the home. The provider had sent us an action plan which stated how they were going to comply with previous regulations they were in breach of. Despite marking the actions as completed, we found they were still non-compliant in some areas. The provider had not made or sustained the necessary improvements from previous inspections. The provider sought feedback from people living at the home, however this information hadn’t been used to make changes or improvements to the home. Improvements had been made to the recruitment of nurses and there were systems in place to ensure their registrations were in date, further improvements were however needed.

People felt there could be more to do within the home and staff had little time to spend with people as they were rushed. Care was task focused and impacted on people’s dignity. Some interactions were not always kind and caring. When people were living with dementia their communication needs had not always been fully considered or the support they needed to make choices.

Infection control procedures were in place and followed. When people complained, they were happy with the outcome, there were complaints procedures in place that the provider followed. People were supported to access health services when needed. Medicines were stored in a safe way. Staff felt listened to and knew who the manager was. Relatives and friends could freely visit the home.

People enjoyed the food and were offered a verbal choice. The provider worked jointly with health professionals who came into the home. The provider was displaying their rating in line with their requirements.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We inspected this service on 7 November 2017. It was an unannounced inspection. Beechfields is a care home that provides accommodation and nursing care. Beechfields is registered to accommodate 35 people. At the time of our inspection 27 people were using the service. Beechfields accommodates people in one adapted building, arranged over two floors. There are two communal lounges, a dining area and a conservatory.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last unannounced inspection on 15 and 19 June 2017, multiple regulatory breaches were identified. On 5 July 2017 we issued a warning notice to the provider in Regulation 12 HCSA (RA) Regulations 2014 Safe care and treatment. This was in relation to the management of medicines and risks to the health, safety and wellbeing of service users. We told the provider to take action by the 15 August 2017. We also judged the service to be ‘Inadequate’ and placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

This meant the service would be kept under review and inspected again within six months.

When we carried out our last inspection on 15 and 19 June 2017, we found concerns relating to how risks to people were managed. Medicines were not administered and managed safely and staff did not always follow guidance to protect people from avoidable harm. We also found improvements were needed to ensure that staff followed legal requirements to uphold people’s rights where they were unable to make certain decisions for themselves and that they followed safe recruitment procedures to ensure persons employed were of good character. We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and to drive improvement. We issued a warning notice to the provider in Regulation 12 HCSA (Regulated Activities) Regulations 2014, Safe care and treatment. This was in relation to the management of medicines and risks to the health, safety and wellbeing of service users. We told the provider to take action by the 15 August 2017. We rated the service as ‘Inadequate’ and the provider was placed into special measures. This meant they would be inspected again within six months with the expectation that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

At this inspection, we found that the provider had made the required improvement in relation to specific concerns identified in the warning notice. However, we have found continued and new breaches of the regulations and have judged that the overall rating for this service is Inadequate. The provider therefore remains in special measures which means we will take action in line with our enforcement procedures to being the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will continue to be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

Medicines were not always managed effectively to ensure they were always available when people needed them and records were not monitored for accuracy. Potential risks to some people’s safety were not consistently assessed and staff did not always have the guidance they needed to ensure people’s safety and wellbeing. People were not effectively protected from the risk of abuse. The registered manager had not ensured that safeguarding incidents were recorded and reported to the local safeguarding team where needed.

There were not always enough staff to meet people’s needs in a timely way and there was no effective system to monitor staffing levels against people’s needs. Improvements had not been made to assure us that safe recruitment procedures were consistently followed to ensure staff were suitable to work in a caring environment. The provider had commenced a programme of training for staff. However, records of staff induction and supervision were not readily available to assure us that the provider had suitable arrangements to support staff to fulfil their role.

People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice

People were involved in planning and reviewing their care but the provider needed to make improvements to ensure people’s diverse needs were taken into account in all areas of their care. People’s day to day health needs were met but were not always referred to other services to ensure that all their needs were met. People were supported to have sufficient amounts to eat and drink to maintain good health.

People and their relatives felt able to raise concern or complaints. However, there was no effective system in place to record and monitor these for any trends to ensure improvements would be made where needed.

The provider’s governance and quality assurance systems were ineffective; they had failed to identify the concerns identified at this inspection or address breaches of regulation highlighted at our last inspection.

People and their relatives were positive about the registered manager and staff and were able to give their views on the service. Although staff were busy, they were caring in their approach and treated people with dignity and respect. They had positive relationships with people and supported them to maintain their independence. People were offered opportunities to take part in activities and follow their interests and their relatives were invited to be involved.

We found a number of continued breaches and a new breach of the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 15 and 19 June 2017 and was unannounced. At our previous inspection on 4 October 2016, the service was rated as requires improvement overall. Improvements were needed to ensure people were supported with decision making, and that quality assurance systems were effective in bringing about improvements.

At this inspection we found that the improvements seen at the last inspection had not been sustained and we identified further concerns with the management of risks associated with people’s care and medicines. Failure to sustain past improvements meant that breaches of the regulations identified at our inspection in November 2015 had reoccurred, giving us little confidence in the provider’s ability to deliver improvements for people living at the home. We found several breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the service was not safe, effective, caring, responsive or well led. The overall rating for this service is Inadequate which means it will be placed into special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Beechfields Nursing Home is registered to provide accommodation and or nursing care for up to 35 people. At the time of the inspection 29 people were using the service, all of whom required nursing care.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found staff did not always follow people's care plans to reduce the risk of avoidable harm and when people’s needs changed, staff did not always act on specialist advice to ensure identified risks were minimised as far as possible. People’s nutritional and hydration needs were not effectively recorded and monitored to ensure their individual needs were met. People's medicines were not administered, stored and recorded safely.

People were not always protected from the risk of abuse because systems were not in place to ensure concerns would be escalated for investigation by the local safeguarding team if needed. Accidents and incidents were not always recorded and monitored to ensure that investigations could take place to minimise the risk of reoccurrence.

Staff were caring in their approach but people were not always treated with dignity and respect. Staff sought people’s consent before supporting them but did not always follow legal requirements when supporting people who lacked the capacity to make their own decisions. People did not always receive personalised support when they needed it.

At lunchtime, staff were not effectively deployed and people did not receive support that met their individual needs. We have recommended that the provider reviews their staffing levels to ensure there are sufficient staff available to meet people’s needs at all times. The provider did not follow safe recruitment procedures to ensure staff were suitable to work with people.

The systems in place to monitor and improve the quality and safety of the service were not effective. There was a lack of leadership and organisation in relation to staff performance and receiving the training they required to fulfil their roles effectively. People and their relatives felt able to raise concerns and complaints but did not always feel action was taken to resolve them. The provider had not listened and acted on people’s feedback to ensure improvements were made where needed.

People were supported to take part in activities that they enjoyed to reduce their risk of social isolation and loneliness.

We found a number of breaches of the regulations. You can see what action we have asked the provider to take at the end of this report.

This inspection took place on 4 October 2016 and was unannounced. At our last inspection on 26 November 2015, the service was rated as Requires Improvement overall. We asked the provider to make improvements to the way they supported people who needed help with decision making; to ensure there were sufficient, suitably recruited, trained and supported staff to meet people’s needs at all times and their quality assurance systems were consistently effective in bringing about improvements at the service. We received an action plan which stated the required improvements would be made by June 2016. At this inspection, we found some improvements had been made but further action was still needed. We also found improvements were needed with the records relating to medicines and the assessment of people’s nutritional needs.

Beechfields Nursing Home is registered to provide care for up to 35 people. There were 30 people living in the home at the time of our inspection, all of whom required nursing care.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection the provider was not acting in accordance with the legal requirements in place to protect people who did not have the capacity to make their own decisions. At this inspection, some improvements had been made but we found there was inconsistency in assessing people's capacity to make some decisions. Further action was needed to ensure the principles of the Mental Capacity Act were appropriately applied and where people were deprived of their liberty, this was in their best interest and legal approval sought.

The provider had made some improvements but further action was needed to ensure people were consistently protected from risks posed by the home environment. Quality audits and checks were carried out by the manager but these needed to be improved to ensure they identified any shortfalls to drive improvement.

Improvements had been made to ensure there were sufficient, suitably recruited staff to meet people’s needs at all times and new staff received an induction to prepare them for their role. However, further action was needed to ensure staff received ongoing training and support to provide effective care.

People received their medicines when needed but improvements were needed to ensure staff followed safe medicines management practice. Risks to people’s health and wellbeing were assessed and staff followed risk management plans to ensure people were protected from avoidable harm. Staff understood their responsibilities and knew how to identify and report any safeguarding concerns to help keep people safe from abuse.

Improvements were needed to ensure people were assured of receiving the appropriate nutritional support. However, overall we saw that people were offered a choice of food that met their needs and preferences. At mealtimes people received the support they needed to maintain a nutritionally balanced diet. People accessed the support of other health professionals when required.

Staff were kind, caring and compassionate and had positive relationships with people. Relatives and visitors were made welcome at the home. Staff treated people with dignity and respect and understood their individual needs. People and their relatives were happy with the care and support provided and told us it met people’s individual needs. People made decisions about their daily routine and were offered opportunities to take part in activities that met their needs and preferences. Staff encouraged people to follow their hobbies and interests and maintain links with the local community.

People and their relatives felt able to raise any concerns or complaints and these were responded to in a timely way. Feedback from people was used to make improvements in the service where possible.

Before our visit we received two whistle blowing concerns about the service. They raised concerns about the ability of the manager to run the home, poor care practices, poor staffing levels and told us that staff were unhappy. Before our visit we asked the provider to investigate these matters. The provider shared the outcome of their investigation with us. We saw that they had carried out a thorough investigation. Their investigation showed that there was no evidence to substantiate the concerns.

We looked at these concerns as part of this inspection visit. We looked at how the service was run. We looked at records kept at the home, observed how the home operated, spoke with people who lived at the home and spoke with staff. We found no evidence to confirm the complainants' concerns. The issues raised were also investigated by the local authority safeguarding team. They have told us that they found no evidence to substantiate the concerns.

We received positive comments about the staff team. One person that lived in the home told us, 'The staff are very kind and care for me well'. One relative told us, 'I have to say I can't praise them enough'.

'Resident's don't get fed properly... Resident's don't get turned at the correct time they are left hours... Each resident gets showered/ bathed once a week. Carers give out medication to the residents and some times gets mixed up. Money goes missing from resident's rooms. Wheel chairs are broken but they still use them... Resident's creams get passed around to other residents. Residents fall and hurt them self no doctor is called to check them over... There is not enough staff to toilet residents so they are left in dirty pads for hours'.

To help us address these concerns we were accompanied on this visit by an expert by experience. This person had the experience and skills needed to communicate and informally observe the daily life of the people who lived in the home.

Our observations showed that staff were busy and at times staff looked rushed. For example we saw that care staff did not always spend sufficient time making sure they had fully met each person's care needs before moving onto the next person.

Relatives we met told us that they had no concerns about the home. One family member said, "I am happy with the care my relative receives. I visit every morning and I am always made welcome by the staff".

It should be noted that we could find no evidence to substantiate the allegations made by the whistle blower.